Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier Low / Median / High Price $616.60 / $2,570.40 / $4,073.80	Facility		$616.60	$2,570.40	$4,073.80
Aetna Facility/Professional Professional Modifier Low / Median / High Price $575.44 / $616.60 / $812.83	Professional		$575.44	$616.60	$812.83
Kaiser Permanente Facility/Professional Facility Modifier Low / Median / High Price $812.83 / $2,454.71 / $3,801.89	Facility		$812.83	$2,454.71	$3,801.89
Molina Facility/Professional Professional Modifier Low / Median / High Price $50.12 / $50.12 / $75.86	Professional		$50.12	$50.12	$75.86
Pacific Source Facility/Professional Facility Modifier Low / Median / High Price $724.44 / $1,819.70 / $1,819.70	Facility		$724.44	$1,819.70	$1,819.70
Regence BlueShield Facility/Professional Facility Modifier Low / Median / High Price $1,698.24 / $2,187.76 / $4,073.80	Facility		$1,698.24	$2,187.76	$4,073.80
United Facility/Professional Facility Modifier Low / Median / High Price $1,949.84 / $2,630.27 / $4,677.35	Facility		$1,949.84	$2,630.27	$4,677.35
United Facility/Professional Professional Modifier Low / Median / High Price $1,071.52 / $1,071.52 / $1,071.52	Professional		$1,071.52	$1,071.52	$1,071.52
Wellpoint Facility/Professional Professional Modifier Low / Median / High Price $363.08 / $363.08 / $1,445.44	Professional		$363.08	$363.08	$1,445.44